[Diagnostics and treatment of primary hyperparathyroidism]

Area of Science:

• Endocrinology
• Surgical Oncology

Background:

• Primary hyperparathyroidism is an endocrine disorder frequently underdiagnosed.
• Classical symptoms include bone pain, osteoporosis, renal calculi, and peptic ulcers, but many patients are asymptomatic or present with non-specific complaints.

Purpose of the Study:

• To review the diagnosis and management of primary hyperparathyroidism.
• To discuss the indications for surgery, particularly in asymptomatic patients.

Main Methods:

• Biochemical diagnosis using calcium, parathormone (PTH) levels, and 24-h urine calcium excretion.
• Localization of parathyroid adenomas via sonography and Tc-99m-MIBI scintigraphy.
• Surgical approaches including traditional 4-gland exploration and focused operative procedures.

Main Results:

• Biochemical diagnosis is straightforward.
• Sonography and Tc-99m-MIBI scintigraphy are sensitive for adenoma localization.
• Surgery is highly successful, with focused techniques offering an alternative to traditional exploration.
• Intraoperative PTH monitoring can confirm success in focused procedures.

Conclusions:

• Primary hyperparathyroidism requires increased clinical awareness due to its prevalence and often subtle presentation.
• While surgery is indicated for symptomatic patients, its role in asymptomatic individuals remains debated.
• Advances in surgical techniques and intraoperative monitoring enhance treatment efficacy.